《金匮要略》中“眩”之辨治思路探析

An Analysis of the Differentiation and Treatment of "Dizziness" in Synopsis of the Golden Chamber

《金匮要略》中“眩”之病机分为虚实两大类:虚为精血亏虚,清窍失养;实为水湿痰饮,上犯清窍,蒙蔽清阳,虚实之间又以水湿痰饮等病理因素为主。水湿痰饮致眩可导致肺中虚冷,津液不布;饮停胸膈,上蒙清阳;脾胃阳虚,饮停心下;膀胱气化不利,水蓄下焦;风湿郁遏;湿热蕴结等。因虚致眩可导致虚劳失精,正虚挟风等。制方合乎“病痰饮者,当以温药和之”和“腰以下肿,当利小便”等治法,用药以利水、健脾、温阳类为主。

In Synopsis of the Golden Chamber,the pathogenesis of "dizziness" can be divided into two categories:deficiency and excess:Deficiency refers to the deficiency of essence and blood resulting in loss of nourishment of clear orifices.Excess refers to fluid-phlegm retention which invades the clear orifices and hoodwinks clear yang.Between deficiency and excess,there are mainly pathological factors such as water dampness and phlegm retention.Dizziness due to water dampness and phlegm retention can lead to deficiency and cold in the lungs and non-distribution of body fluid.If water dampness stops at the chest diaphragm,it may hoodwink clear yang.If the spleen-stomach yang is deficient,water retention may stop under the heart.If bladder gasification is unfavorable,it can lead to water storage in lower energizer.Wind dampness may lead to depression.Dampness and heat may lead to accumulation.Dizziness due to deficiency can lead to consumptive disease,deficient healthy qi carrying wind,etc.The commonly-used formulas conform to the treatment methods of "those who are sick with phlegm retention treated with warm medicine" and "those who are swollen below the waist treated with promoting diuresis".The drugs are mainly used to induce diuresis,strengthen the spleen and warm yang.